Understanding potential costs is an important part of the patient experience when planning for care, and hospitals and health systems are committed to helping patients navigate that process. That is why the hospital field is developing and deploying tools to help patients get the information they need. Hospitals also have policies in place to assist patients who cannot pay for part or all the care they receive.
As part of this work, hospitals are implementing the various federal price transparency requirements, which include posting machine-readable files with a variety of different rate information, as well as a consumer-friendly display of rate information for at least 300 shoppable services. The Centers for Medicare & Medicaid Services (CMS) recently released the results of its assessment of hospital compliance. Importantly, CMS is the official arbiter of compliance with the transparency rules.
CMS found that in 2022, 70% of hospitals had complied with both the consumer-friendly display of shoppable services information and the machine-readable file requirements, up from 27% in 2021. When you dig deeper, the numbers were even higher: 82% met the consumer-friendly display of shoppable services information requirement in 2022 (up from 66% in 2021), and 82% met the machine-readable file requirement (up from 30% in 2021). These numbers show significant progress on the part of hospitals implementing these requirements and are unsurprising given the unprecedented challenges hospitals continued to face in 2021 with respect to the COVID-19 pandemic and workforce crisis.
Unfortunately, several third-party organizations repeatedly have proclaimed various rates of hospital compliance with federal price transparency policies that simply are not based on the facts. We addressed this concerning activity in this blog post last year. Earlier this month, one such third-party – Patient Rights Advocate (PRA) – released another paper that again blatantly misconstrues, ignores, and mischaracterizes hospitals’ compliance with federal regulations.
Below are several specific examples of where PRA continues to misrepresent data or simply get the facts wrong, according to CMS, which again is the only true arbiter of hospital price transparency compliance. These inaccuracies undermine the purported findings in the paper, and we strongly urge caution in basing any determinations of hospitals’ compliance on flawed analysis by third parties that have their own agenda. Hospitals and health systems look forward to continuing to work with CMS to deliver reliable and useable pricing information to patients.
- PRA: “Our latest review of hospital compliance, completed just over two years after the Hospital Price Transparency Rule’s implementation, analyzed the websites of 2,000 U.S. hospitals focusing on the nations’ largest health systems, and found only 24.5% of them (489) to be compliant with all the requirements of the rule.”
- CMS: “hospitals are putting the hospital price transparency requirements into practice, demonstrating a substantial increase in hospitals meeting website assessment criteria from 27 percent to 70 percent between 2021 and 2022…”
- PRA: “We deemed files noncompliant due to incomplete or missing data fields, formulas instead of actual dollar amounts as prices, or fields with zeros, blanks and asterisks for negotiated rates.”
- On using formulas instead of dollar amounts: “It is possible that a hospital may have established a payer-specific negotiated charge that cannot be displayed as a standardized dollar amount. In these situations, the hospital may indicate the standardized algorithm as its payer-specific negotiated charge in the machine-readable file.”
- On fields with zeros, blanks, and asterisks for negotiated rates: “The rule at 45 C.F.R. 180.60 requires that hospitals make public several data elements, including all five types of standard charges, as applicable, in the machine-readable file. We believe the “as applicable” reference is reasonable and necessary, given differences across hospitals that are subject to the regulations. We encourage hospitals to consider taking steps beyond the display requirements of the Hospital Price Transparency regulations to improve the public’s understanding of the data the hospital has posted in its machine-readable file, and, in particular, to clarify why there may appear to be data missing from the machine-readable file.” (Emphasis added)
- PRA: “We also observed an increased usage of 'N/A's in pricing files without any disclaimer or explanation.”
- CMS: “When an item or service does not have a corresponding standard charge associated with an item or service, we strongly recommend your hospital use a single indicator, such as “-1,” “N/A,” or other method to communicate to the public that there is no corresponding standard charge.”
- PRA: “Also of note, a significant number of hospitals posted their files in obscure locations on their websites”
- CMS: “As explained in the CY 2022 OPPS/ASC proposed rule, in our experience, many publicly available web pages that are selected by hospitals to host the machine-readable file (or a link to the machine-readable file) are discoverable using simple internet searches (using key words such as the hospital name plus ‘standard charges,’ ‘price,’ or ‘machine-readable file’) or, for example, by navigating to the hospital’s home page and clicking and searching through pages related to patient billing and financing. We noted that because of the flexibility we allowed to hospitals to choose the internet location, we recognized and expected that there would be some variability in how hospitals choose to publicly display their machine-readable file and how quickly the file can be found by the public. However, we indicated our belief that this flexibility is afforded under the regulation so long as the hospital ensures that the machine-readable file is accessible ‘‘without barriers,’’ including that the file and its contents would be digitally searchable (84 FR 65561 through 65562).”
- PRA: “A growing number of hospitals posted encoded, complex JSON-formatted files without user documentation.”
- CMS: “What is a ‘machine-readable’ file format? A machine-readable file format is a digital representation of data or information in a file that can be imported or read into a computer system for further processing. Examples of this format include, but are not limited to, .XML, .JSON, and .CSV formats.” (Emphasis added)
- PRA: “We found a significant increase in the number of hospital pricing files that are one to seven gigabytes (GB) or larger, making it onerous for researchers, technology innovators, and consumers to download, although many large hospitals have successfully created compliant files less than 200 megabytes (MB) in size.”
- CMS: “We note that many machine-readable data sets that are made available for public use can be quite large. For example, Medicare Provider Utilization and Payment Data files include information for common inpatient and outpatient services, all physician and other supplier procedures and services, and all Part D prescriptions…we have not heard that large Medicare data files of data derived from claims causes any confusion for healthcare consumers, and healthcare consumers do not typically use the information in the data files directly. Instead, voluminous Medicare data is used by a variety of stakeholders, some of whom take the information and present it to users in a consumer-friendly manner.”
Molly Smith is AHA’s group vice president of public policy. Aaron Wesolowski is AHA’s vice president of policy, research and analytics strategy. Terrence Cunningham is AHA’s director of administrative simplification policy.